What is the management plan for a patient with hypertension, intermittent paresthesia in hands, and weight management concerns on Amlodipine (calcium channel blocker) 5mg daily?

Management of Hypertension and Paresthesia in a Patient on Amlodipine

For this patient with hypertension (BP 142/80), intermittent paresthesia in the hands, and on Amlodipine 5mg daily, the recommended management is to continue Amlodipine at the current dose and add lifestyle modifications, while the paresthesia symptoms should be monitored as they are likely related to positional compression rather than requiring specific intervention. 1, 2

Blood Pressure Management

Current Assessment

• BP 142/80 mmHg indicates uncontrolled hypertension despite Amlodipine 5mg daily
• Patient is on a calcium channel blocker (Amlodipine), which is an appropriate first-line agent 1
• No significant side effects from current medication reported

Recommended Pharmacological Management

1. Continue Amlodipine 5mg daily

   • The current dose is appropriate as initial therapy 2
   • Allow 6-8 weeks for full effect before considering dose adjustment 3
   • If BP remains >140/90 mmHg after 6-8 weeks, consider increasing to 10mg daily 2

2. Consider combination therapy if BP remains uncontrolled

   • If BP remains elevated after optimizing Amlodipine dose, add a second agent
   • Preferred combinations include adding an ACE inhibitor or ARB 1
   • Fixed-dose combinations improve adherence 1

Lifestyle Modifications

1. Diet

   • Implement DASH diet rich in fruits, vegetables, whole grains, and low-fat dairy 1
   • Restrict sodium to <2,300 mg/day 1
   • Increase potassium-rich foods 1

2. Physical Activity

   • Recommend 150 minutes of moderate-intensity aerobic exercise per week 1
   • Suggest specific activities compatible with her physically active job

3. Weight Management

   • Discuss healthy weight targets if applicable
   • Target BMI of 20-25 kg/m² 1

4. Stress Management

   • Address increased stress from moving house
   • Consider mindfulness practices 1

Management of Hand Paresthesia

Assessment of Symptoms

• Intermittent pins and needles in fingers, more on right side
• Associated with holding phone, repetitive hand use, and nighttime
• Negative Phalen's and Tinel's tests
• Normal sensation, power, and grip strength
• No clumsiness or dropping objects

Likely Diagnosis and Management

• Symptoms are consistent with positional nerve compression rather than carpal tunnel syndrome
• Recommendations:
  1. Ergonomic adjustments at work (proper keyboard and mouse position)
  2. Regular breaks during repetitive tasks
  3. Wrist neutral position during sleep
  4. Avoid prolonged gripping of phone (use speaker or headset)
  5. Monitor symptoms and return if worsening or new symptoms develop

Relationship to Hypertension Treatment

• Paresthesia is not a common side effect of Amlodipine 2, 4
• Symptoms are more likely related to occupational factors (bookkeeping with extensive typing)
• No need to adjust antihypertensive medication based on these symptoms

Follow-up Plan

1. Blood Pressure Monitoring

   • Home BP monitoring twice daily for 7 days before next visit
   • Return in 4-6 weeks to reassess BP control 1

2. Laboratory Monitoring

   • Check serum creatinine, eGFR, and potassium (baseline and annually) 1
   • Consider checking ferritin levels given history of low-normal ferritin

3. Preventive Care

   • Discuss mammogram screening given maternal history of breast cancer
   • Continue regular cervical screening

Potential Pitfalls and Caveats

1. Medication Adherence

   • Ensure patient understands the importance of daily medication
   • Discuss timing of medication (can be taken at most convenient time) 5

2. Misdiagnosis of Paresthesia

   • If symptoms worsen or change in character, reconsider diagnosis
   • Watch for development of motor symptoms which would warrant urgent evaluation

3. Inadequate BP Control

   • Don't delay appropriate intensification of therapy if BP remains elevated
   • Target BP should be 120-129 mmHg systolic if tolerated 5

4. Monitoring for Medication Side Effects

   • Watch for peripheral edema, which occurs in some patients on Amlodipine
   • If edema develops, consider switching to another agent or adding an ACE inhibitor/ARB

By following this management plan, the patient's hypertension should be better controlled while addressing her paresthesia symptoms through conservative measures.